Overview

HOCM is a genetically inherited disease characterized by asymmetric hypertrophy of the left ventricular septum. Two-thirds of these patients have malformations of the mitral valve which can cause dynamic left ventricular outflow obstruction. These patients are at risk of sudden cardiac death.

Pathyophysiology

• Dynamic obstruction to LV outflow
• Diastolic dysfunction
• Myocardial oxygen supply-demand imbalance
• Supraventricular and ventricular tachyarrhythmias

Medical Management

• Beta blockers, calcium channel blockers, amiodarone, and disopyramide
• ICD indicated in high risk patients (cardiac arrest, familial sudden death, syncope, repetitive NSVT, hypotension with exertion, CAD, massive LVH)

High Yield Checklist

• [ ] Relative bradycardia
• [ ] Maintain preload
• [ ] Avoid increases in contractility
• [ ] Maintain SVR elevated
• [ ] Aggressively treat arrhythmias
• [ ] Beware of postop complications such as VSD, heart block, arrhythmias

Comprehensive Checklist

Preoperative